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. 2003 Feb;52(2):181-5.
doi: 10.1136/gut.52.2.181.

Eosinophilic oesophagitis: a novel treatment using Montelukast

S E A Attwood  1 , C J Lewis, C S Bronder, C D Morris, G R Armstrong, J Whittam
Affiliations

Eosinophilic oesophagitis: a novel treatment using Montelukast

S E A Attwood et al. Gut. 2003 Feb.

Abstract

Background: Eosinophilic oesophagitis is a rarely diagnosed condition involving eosinophil infiltration of the oesophageal mucosa and creating significant symptoms of dysphagia. Failure to diagnose this disorder relates to reluctance to biopsy an apparently normal oesophagus. This is essential for histological diagnosis. To date, treatment success has been achieved only with corticosteroids. We describe here the use of an eosinophil stabilising agent Montelukast for the symptomatic relief of these patients.

Patients and methods: Twelve patients have been identified with this condition in our unit since 1995, after thorough investigation of their dysphagia. We commenced eight of these patients on the leukotriene receptor antagonist Montelukast to symptomatically improve their swallowing while avoiding the use of long term corticosteroids.

Results: Many of these patients had been previously misdiagnosed, and therefore inappropriately and unsuccessfully treated for an extensive period prior to referral to our unit. All patients were unresponsive to acid suppression therapy alone but showed improvement in their swallowing on Montelukast. Six of eight reported complete subjective improvement, five patients remaining completely asymptomatic on a maintenance regimen.

Conclusions: Eosinophilic oesophagitis is a disease that is often misdiagnosed due to lack of awareness and reluctance of clinicians to biopsy an apparently normal oesophagus in dysphagic patients, and therefore obtain a histological diagnosis. Investigation of these patients adds further evidence to this condition being a separate pathological state from gastro-oesophageal reflux and eosinophilic enteritis. Montelukast has been found to be of significant help in the symptomatic control of these patients while avoiding long term corticosteroids use.

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Figures

Figure 1
Figure 1
Endoscopic view of a dysphagic patient with eosinophilic oesophagitis, illustrating clearly a concentric ring pattern.
Figure 2
Figure 2
Endoscopic view of a dysphagic patient with eosinophilic oesophagitis, illustrating linear furrows.
Figure 3
Figure 3
Combination of furrows and rings creating a cobblestone effect seen in eosinophilic oesophagitis at endoscopy.
See this image and copyright information in PMC

Comment in

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